Health outcomes of experiencing poverty in the early years: evidence review

Conclusions

This report presented evidence that exposure to poverty in utero and during the early years can have a profound and lasting impact on child outcomes, influencing health and development in the short-, medium- and longer-term. In this context, optimising child health and preventing health inequalities from the early years and throughout the life course requires consideration of factors that begin well before birth and conception. Several key conclusions emerge, highlighting the complexity of the landscape in this area, as well as challenges and opportunities.

One key conclusion is that the cross-cutting nature of child poverty makes it challenging for any single study or report to fully explore and capture all aspects of the relationship between child poverty and health. This is reflected in the complexity of policies in this area, with the findings collectively emphasising the need for a multifaceted approach to addressing the issue, wrapping around families and considering risk and protective factors for both parental and child health. The literature agrees that effective policies and interventions will be those that address multiple health factors at once.

Extensive evidence demonstrates that children facing poverty and deprivation are at a higher risk of poor health outcomes, contributing to health inequalities. However, these trends are not inevitable. While some issues may not be entirely preventable, research emphasises the importance of adopting a long-term, life course approach to child and family health; one rooted in primary prevention across preconception, pregnancy and the early years.

A stronger emphasis on prevention and early intervention could provide a valuable opportunity for more children to reach their full potential. This involves influencing preconception thinking, understanding and addressing environments and behaviours that may create risks in pregnancy, and supporting parents in providing sensitive, nurturing care after birth. Identifying key levers to reduce parental stress as early as possible in their parenting journey is also essential.

To maximise impact, primary prevention must be embedded across policies, with investment in early years reinforced at other critical stages of development, such as adolescence and beyond. A sustained, continuous support approach – rather than short-term solutions – is crucial in ensuring long-term health and wellbeing. Strategies to address poverty are equally important as those focused on health. Actions in the tackling poverty space must be integrated with actions in the health space to strengthen children and family support.

The evidence base emphasises the necessity, value, and potential of universal services during pregnancy and early childhood. These services provide critical support, such as income maximisation, and have the capacity to reach a broad segment of the population. There is also recognition that targeting vulnerable groups before issues arise can help support a shift to prevention. While targeted interventions are often referenced, their application requires caution. Targeting based on SIMD has limitations, as it may not capture all families in need. Moreover, pregnancy and early childhood are highly dynamic periods, during which families may transition into poverty within short time frames. Therefore, maintaining universal access to services remains essential, with targeted support considered carefully to ensure inclusivity and effectiveness.

Additionally, the review highlights the need for rigorous evaluation and assessment of policies and interventions. Child health indicators are important for developing a common information base to identify challenges and set policy priorities, along with indicators outside of health and other types of evidence, such as qualitative data. There is an ongoing need to consistently integrate children's needs into all policies and measures, ensuring analysis includes households with children rather than focusing solely on the adult population, as well as speaking to children directly.

Furthermore, there is a need to improve data availability where gaps exist, focusing on longitudinal and linked data, as these can provide insights into the long-term effects of interventions, as well as improving the completeness of data overall. There is also a need to use data to inform and support the allocation of resources towards preventive initiatives and those proven to be effective. Beyond improving existing datasets, exploring additional ways to capture key social and economic factors could offer broader perspectives for measuring and addressing child poverty, deprivation and health inequalities. Additionally, strengthening the representation of children's voices in data collection and decision-making processes could enhance the relevance and impact of policies and actions affecting them.

To summarise, addressing child poverty and its far-reaching health outcomes requires actions that are system-wide, implemented at both local and national levels, timely, multidimensional, data-driven, and impact-focused. Such efforts can underpin a system that prioritises prevention and the quality and safety of care for children and young people, laying the foundation for ‘a Scotland where people live longer, healthy and fulfilling lives’^[474].